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Sunday, February 14, 2010

Temporal Tendinitis: A Migraine Mimic Temporal Tendinitis is a very common disorder frequently misdiagnosed and/or mistaken for migraine.

There was an excellent article in Practical Pain Management by Edwin A Ernst III DMD on Temporal Tendinitis. Common pain reference sites (according to the article) for this condition include: Painful TM Joints (Temporomandibular joint or TMJ), Ear Pain and/or stuffiness in the ear, retro-orbital pain sometimes radiating to occiput and /or shoulder, upper and lower aching teeth, pain in or around the eye, pain in the lateral temple area, and occasionally pain in the area of the stylomandibular ligament. These pains are frequently accompanied by prodromal symptoms similar to migraine of Nausea, vomiting, photophobia and visual disturbances.

This can be extremely intense pain and is frequently initiated by trauma such as an auto accident. Many patients with this disorder can have trouble fitting their back teeth together. The pain can be unilateral or bilateral and patients will frequently use analgesics, opiods or visit hospital ER's because of the pain severity. Physicians rarely palpate the coronoid tendon therefore these patients are easily misdiagnosed. Intra-oral palpation is essential in the diagnostic process and most physicians are not trained in palpation of these important structures. Dr Ernst coined the phrase "The Migraine Mimic " in 1983 but many physicians are not familiar with craniofacial pain literature.

The actual problem is a tendenosis of the temporal tendon at the tip of the coronoid process. Increasing the pressure of palpation causes increases in the level of the pain. If a Migraine Mimic headache is evoked use of lidocaine diagnostic injection should lessen or alleviete the pain.

Treatment with local anesthetic and Sarapin and/or Steroid is recommended by Dr Ernst and if this is not curative he recommends radio-frequency thermoneurolysis. I have never found this to be necessary and prefer to try prolotherapy as a first line treatment and if that is not effective then utilize a steroid. If the pain is exquisitely acute than beginning with steroid may be advantageous.

Temporal tendinitis can also be found in chronic muscle disorder from chronic pathology but is usually significantly less intense. Patients can suffer for years with this condition and be treated for migraines with poor results and no long term resolution.

I still recommend correction of the neuromuscular position of the mandible with a diagnostic orthotic even when temporla tendinitis is diagnosed. If total relief is achieved a reevaluation of baseline jaw position is recommended before phase 2 therapy.

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posted by Dr Shapira at 1:58 PM

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